# WAC 182-530-3100: WAC 182-530-3100. How the medicaid agency determines when a drug requires authorization

> Washington · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3100

## Section

- **Citation:** WAC 182-530-3100
- **Heading:** WAC 182-530-3100. How the medicaid agency determines when a drug requires authorization
- **Jurisdiction:** Washington
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Washington Administrative Code / Title 182 / Chapter 182-530 / Section 182-530-3100

## Text

(1) The medicaid agency's pharmacists or medical consultants periodically evaluate covered drugs, covered indications, or new dosages approved by the Food and Drug Administration (FDA) to determine the drug authorization requirement.
(a) The clinical team evaluates and grades available information for each drug or drug class based on quality evidence contained in compendia of drug information and peer-reviewed medical literature. The information evaluated includes, but is not limited to:
(i) Evidence for efficacy and safety;
(ii) Cost comparisons of drugs with similar existing drugs;
(iii) Potential for clinical misuse;
(iv) Potential for client misuse or abuse;
(v) Drugs with a narrow therapeutic index;
(vi) Other safety concerns; or
(vii) Product cost and outcome data demonstrating the cost effectiveness of the drug, device, or drug-related supply.
(b) In performing this evaluation the clinical team may consult with other agency clinical staff, financial experts, and program managers. The agency clinical team may also consult with an evidence-based practice center (EPC), evidence-based drug reviews, other purchasers, the drug use review (DUR) board, and medical experts in this evaluation.
(c) Based on the clinical team's evaluation, the agency may determine that the drug, device, or drug-related supply:
(i) Requires authorization;
(ii) Requires authorization to exceed agency-established limitations; or
(iii) Does not require authorization.
(2) The agency periodically reviews existing drugs, devices, or drug-related supplies and reassigns authorization requirements as necessary according to the same provisions as outlined above for new drugs, devices, or pharmaceutical supplies.
(3) For any drug, device, or drug-related supply with limitations or requiring authorization, the agency may elect to apply automated authorization criteria according to WAC 182-530-3200 .

## Nearby sections

- [WAC 182-530-1000 WAC 182-530-1000. Outpatient drug program—General](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_1000.md)
- [WAC 182-530-1050 WAC 182-530-1050. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_1050.md)
- [WAC 182-530-1075 WAC 182-530-1075. Requirements—Use of tamper-resistant prescription pads](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_1075.md)
- [WAC 182-530-1080 WAC 182-530-1080. Requirements for prescribing and dispensing controlled substances — Prescription monitoring program (PMP)](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_1080.md)
- [WAC 182-530-2000 WAC 182-530-2000. Covered — Outpatient drugs, devices, and drug-related supplies](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_2000.md)
- [WAC 182-530-2100 WAC 182-530-2100. Noncovered — Outpatient drugs and pharmaceutical supplies](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_2100.md)
- [WAC 182-530-3000 WAC 182-530-3000. When the medicaid agency requires authorization](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3000.md)
- [WAC 182-530-3100 WAC 182-530-3100. How the medicaid agency determines when a drug requires authorization](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3100.md)
- [WAC 182-530-3200 WAC 182-530-3200. The medicaid agency's authorization process](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3200.md)
- [WAC 182-530-4000 WAC 182-530-4000. Drug use review (DUR) board](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4000.md)
- [WAC 182-530-4050 WAC 182-530-4050. Drug use and claims review](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4050.md)
- [WAC 182-530-4100 WAC 182-530-4100. Medicaid preferred drug list (medicaid PDL)](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4100.md)
- [WAC 182-530-4125 WAC 182-530-4125. Generics first for a client's first course of treatment](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4125.md)
- [WAC 182-530-4150 WAC 182-530-4150. Therapeutic interchange program (TIP)](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4150.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3100. Check the current official text before relying on it. Not legal advice.